
<!DOCTYPE html>
<html>
<head lang="en">
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no">
    <title>银联回呼充值</title>
    <link rel="stylesheet" href="../css/wzl-bootstrap.css?q=1111"/>
    <link rel="icon" href="../favicon.ico" type="image/x-icon" />
    <link rel="shortcut icon" href="../favicon.ico" type="image/x-icon" />
    <script src="../js/dist/seajs/2.3.0/dist/sea.js"></script>
    <script>
//        seajs.config({
//            base:'../js/dist'
//        })
//        seajs.use('wzlh5/1.0.0/index',function(index){
//            index.register();
//        })
        seajs.config({
            base:'../js/dist'
        })

        seajs.use('wzlh5/1.0.0/user',function(register){
            register.register();
        })
    </script>
</head>
<body>
<div id="warp">
    <div class="top-buff-bar"></div>
    <nav class="wzl-navbar navbar-default" role="navigation">
        <div class="container-fluid">
            <div class="navbar-header">
                <div class="wzl-nav-bar">
                    <span class="glyphicon glyphicon-wzl-back" onclick="history.back(-1)"></span>银联回呼充值
                </div>
            </div>
        </div>
    </nav>

    <div class="unioncall-form-control">
        <select class="form-control pl10">
            <option>选择银行</option>
            <option>2</option>
            <option>3</option>
            <option>4</option>
            <option>5</option>
        </select>
    </div>

    <div class="unioncall-form-control clearfix">
        <div class="pull-left unioncall-form-control-list pl10">
            <span>银行所在地：</span>
        </div>

        <div class="pull-right unioncall-form-select ">
            <select class="form-control pl10">
                <option>选择省</option>
                <option>2</option>
                <option>3</option>
                <option>4</option>
                <option>5</option>
            </select>
        </div>

        <div class="pull-right unioncall-form-select pl10">
            <select class="form-control">
                <option>选择市</option>
                <option>2</option>
                <option>3</option>
                <option>4</option>
                <option>5</option>
            </select>
        </div>

    </div>

    <div class="container">
        <form action="" role="form" class="">
            <ul class="unioncall-list-group" >
                <li class="unioncall-list-group-item ">
                    <input type="text" class="form-control" name="username" value="" placeholder="支付宝账号（必填）"/>
                </li>
                <li class="unioncall-list-group-item clearfix">
                    <span class="form-control">*宏招</span>
                </li>
                <li class="unioncall-list-group-item clearfix">
                    <span class="form-control">11111111111111111111</span>
                </li>
                <li class="unioncall-list-group-item clearfix">
                    <div class="pull-left">
                        <input type="password" class="form-control wzl-verify-input"placeholder="我中啦密码（必填）"/>
                    </div>
                </li>
            </ul>
        </form>

        <a href="javascript:;" class="btn btn-wzl-default btn-lg btn-block wzl-mb-20"> 提交绑定</a>

        <div class="form-group wzl-mb-40">
            <p class="text-muted"> <span class="wzl-text-warning">温馨提示: </span><br>支付宝开户信息必须与您在网站实名认证的信息一致，不一致将无法使用支付宝提现。如需更改支付宝信息，请拨打客服电话：4006865015
            </p>
        </div>
    </div>
</div>
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</body>
</html>